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Patient Orders May Not be Sent by Text Message

on Friday, 2 February 2018 in Health Law Alert: Erin E. Busch, Editor

The Centers for Medicare & Medicaid Services (CMS) recently reaffirmed its prohibition against “Licensed Independent Practitioners” (LIPs) issuing patient orders via text message. CMS clarified that “the practice of texting orders from a [LIP] to a member of the care team is not in compliance with the Conditions of Participation (CoPs) or conditions of Coverage (CfCs).” CMS has consistently held this position.

However, during the second half of 2016, The Joint Commission (TJC) muddied the waters by stating that it would permit patient orders transmitted by secure “short message service” (“SMS”) text–a position out of step with the CMS position.

In the December 2016 issue of its newsletter, TJC rolled back its earlier SMS advice and notified its members that secure text messaging for patient care orders is not acceptable. The notification indicated that in “collaboration with [CMS], [TJC] developed . . . recommendations” to prohibit transmission of a verbal order by text, but to permit secure transmission of patient information by SMS.

The TJC article focused on the positive, explaining that with appropriate policies and monitoring, providers may use SMS to share patient health information that is subject to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Some LIPs saw only this positive HIPAA analysis and missed the prohibition on sending orders by text. CMS accordingly determined to issue additional guidance.

CMS therefore published “Texting of Patient Information among Health Providers,” a memorandum dated December 28, 2017, stating that “CMS does not permit the texting of orders by physicians or other health care providers.” Rather, an “LIP should enter orders into the medical record via a hand written order or via CPOE [computerized order entry].” The memorandum repeatedly quotes the section of the CoPs that requires a medical record to include all authenticated provider orders, 42 C.F.R. § 482.24, but persistently cites Section 489.24 in error. Despite this confusing typographical error, the intent of the memorandum is clear.

Regardless of whether or not your hospital is TJC-accredited, LIPs on staff were never permitted to enter orders by text. CMS permits texting HIPAA-protected patient information only “through a secure platform,” which may include SMS. CMS prefers CPOE with immediate download into the record, and continues to permit hand written orders that promptly become part of the record. Given that confusion has existed on this issue despite previous efforts to clarify it, hospital administrations may consider having their medical staff offices issue copies of the new memorandum to all LIPs.

Thomas S. Dean

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